Overcoming shoulder dystocia with the Zavanelli maneuver: a case report

Introduction and importance: Shoulder dystocia is a rare but serious obstetric emergency that can cause severe complications for both mother and baby. Rapid and effective intervention is crucial to avoid adverse outcomes. Case presentation: A 38-year-old woman with gestational diabetes and a history of two cesarean sections presented at 38 weeks and 6 days of gestation in labor. Despite risk factors for shoulder dystocia, vaginal delivery was attempted. After the head delivered, the fetal shoulder became impacted. Standard maneuvers, including McRoberts, suprapubic pressure, and the "All Fours" position, failed to resolve the dystocia. Ultimately, the Zavanelli maneuver was performed, returning the fetal head to the uterus, followed by an emergency cesarean section. The infant was born with a low Apgar score, requiring resuscitation and NICU admission, but was discharged in good condition after ten days, with no signs of Erb's palsy. Clinical discussion: This case emphasizes the importance of anticipating shoulder dystocia in high-risk patients and being prepared for advanced interventions. Although the Zavanelli maneuver is rarely performed due to its technical difficulty and associated risks, it can be life-saving when executed promptly by an experienced team. Conclusion: This report demonstrates the successful use of the Zavanelli maneuver after all other methods failed. Timely and skilled application of this maneuver can prevent devastating complications and underscores the need for preparedness and training in managing severe shoulder dystocia.